Audits and Coding Quality Reviews

The OIG and CMS recommend “regular” reviews, but give no guidance as to frequency. We suggest that our clients establish an annual budgetary amount, and then stagger it in quarterly reviews instead of one large annual evaluation. The cost is the same and has three major benefits. First, the expense of the audit is spread throughout the year. Second, the providers and coders receive feedback on the status of the coding throughout the year. Third, a program of regular quarterly feedback provides an opportunity to correct the errors identified and then confirm that the corrective action has been effective without having to wait an entire year. If coding errors continue to occur, then a targeted plan of action can be instituted.

The implementation and operation of this program is quite simple. Periodically (monthly, quarterly, semi-annually, or annually) participating practices send us a representative sample of their visit notes, procedure reports and claim forms. We perform a government-style audit of the coding, using all available screens and regulations. We then send you a case-by-case analysis of our findings. Our medical coding and surgical coding accuracy evaluations are designed to be part of a continuous quality improvement program. It gives our clients’ medical coders and surgical coders the feedback they need to more accurately code the patient-care services.

Have you been the target of a compliance audit? If you think you’re being treated unfairly, let us “audit the auditors.” Our findings can be your best defense!

Latest Blog Posts:

DOJ Pursues a Number Of EHR Cases: Five Things For You to Understand

June 21st, 2019|Comments Off on DOJ Pursues a Number Of EHR Cases: Five Things For You to Understand

The United States DOJ is initiating direct legal proceedings against Hospitals, Health Care systems, and Medical Technology Corporations for submitting an exhaustive number of false claims to both Medicare and Medicaid. This action is in [...]

Kansas Doctor Forks Over Almost 6 Million in Settling 3rd False Claims Case in Twenty Years

June 19th, 2019|Comments Off on Kansas Doctor Forks Over Almost 6 Million in Settling 3rd False Claims Case in Twenty Years

Joseph P. Galichia MD, the previous owner of the Wichita-based Galichia Medical, after quite some time, reached Fraud Claim Act settlements with the Feds in 2000 and 2009 amounting to nearly 6 Million Dollars. This [...]

Westside Los Angeles Dentist Being Sent To Prison

June 18th, 2019|Comments Off on Westside Los Angeles Dentist Being Sent To Prison

A West Los Angeles dental practitioner was sentenced last week to forty months in federal jail for a health-care insurance fraud scheme during which he submitted phony billings for crowns and fillings that were not [...]